HomeMy WebLinkAbout1985-11-12 Permit, Septic System #8178GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 5.1323
(612) 473-7-7,3p57�
OwnerC
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Contractor �-p�
City License No. o" , n
REMARKS AND SPECIAL CONDITIONS
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PERMIT TYPE AND FEE:
�J NEW
/\
Inside Plumbing (#fixtures_)
Fee
Water Meter (Size—)
Fee
Meter #
Remote #
icipal Water Connection
Fee
[]Copper
Muni •ipal Sewer Connection
Fee
❑ PVC [7 Cast
❑__
MWCC SAC Charge
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On Site Septic System
Fee
ACKNOWLEDGEMENT
CITY PERMIT NO. 8178
Date
Address v I
Address
state License No,
❑ ADDITION
❑ REPAIR
S —
Water Well
Fee
S
S ___
Mechanical F•quipment
Fee
S
Moving /Lifting BuildingF
Fee
S
S _
Land Alteration (Excavation,
Fee
S
Grading, Filling, etc.)
S —
Fire
I-ee
S
Sprinkler System (Fire)
Fee
S
S
Other:
Fee
S
S '�
After -the -fact Investigation
Fee
S
The undersigned herel., acknowledges receipt of this limited
permit, including aeee, of all special Information,
terms, conditions or _rements written above. The
undersigned understanew .nd agrees under penalty of law
that this permit is suictly limited in scope to the work,
activity or improvement specified; that Oils permit does
not grant any authority to do work or activities requiring
separate permit approvals; and that this permit does not
grant authority to violate env provision of any City
ordinance or State law, rule or ._gulation. All work shall be
done In strict compliance with all City ordinan,es, buuding
codes and/or health department regulations, and shall be
subject to Inspect' ,n, approval or reJection t•v the City.
Whsne.er to ordered, the undersigned agree, to correct
any work found to be irviolation of the conditions of
thi- permit
Sig
Cirt:f Applicant
-
TOTAL
State Surcharge:
Fee S
Total Amount Paid to City Fee SS�
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official. I
Signature,pf City
Code. White A de Copy Csnary Inspector's Copy Pink—Finan-c Copy
-Applicant's P •-eipt